Project Summary/Abstract Low-income and minority populations with cancer experience greater rates of untreated symptoms, emergency department (ED), and hospital use at the end-of-life (EOL) compared with non-minority patients. Communication of patients' EOL care preferences with their healthcare providers can improve care, however, communication barriers between low-income and minority patients and their healthcare providers limit engagement in these discussions. In one Veterans Affairs (VA) facility, we hired and trained lay health workers (LHWs) to assist patients in communicating their EOL preferences to their providers. The intervention lowered ED and hospital use and increased hospice use as compared to Veterans who received usual cancer care. The feasibility and efficacy of this approach in non-VA, community settings remain untested. The objective of this study is to expand the LHW intervention to underserved community settings. The hypothesis is that this approach is feasible and acceptable in the community and can improve patients' quality of life and reduce unwanted EOL healthcare utilization. The candidate and research team will partner with Unite Here Health (UHH), a labor union health organization that provides health benefits for low-income and minority hourly-wage workers. In Aims 1 and 2, the candidate and team will use a unique combination of community-based participatory research (CBPR) and expert panel methods to synthesize perspectives of UHH patients, caregivers, oncology providers and an expert panel to refine the LHW intervention. In Aim 3, the candidate will pilot the refined intervention among 120 patients diagnosed with advanced stages of cancer to determine feasibility and efficacy of the intervention as compared to usual cancer care alone. Results will inform a future, planned multi-center trial. Successful completion of this award has tremendous potential to improve EOL cancer care for vulnerable populations and inform similar approaches nationally. The candidate, Dr. Manali Patel, is a Stanford University oncologist and health services researcher. Her short-term career goals are to gain expertise in community-based participatory research (CBPR) and expert panel methods to refine evidence-based cancer interventions to eliminate disparities for minority and low-income patients in communities. This award will support Dr. Patel's training in the following that draw on mentors' expertise in: 1) CBPR and expert panel methodology (Mentor: Jay Bhattacharya, Co-Mentor: Tumaini Coker) and 2) economic evaluation of healthcare system innovations (Mentor: Jay Bhattacharya). This award will lay the groundwork for an R01 that Dr. Patel will prepare as the next step towards an independent research career. These activities will facilitate the candidate's growth as an independently funded researcher whose long-term goal is to pursue and conduct research in the area of health systems redesign that results in improved health outcomes for low- income and minority patients with cancer. !